Abortion Mills Thriving Behind Secrecy and Fear

It is a shadowy business, the unregulated world of abortion mills, shabby clinics operating behind the facades of doctors' offices, often in poor neighborhoods. Its victims are women who know little about legal rights or medical options, who have seen an ad or heard a tip and come to this -- driven by fear and loneliness or fates beyond invention -- to risk butchery on a table.

No one knows how many such fly-by-night surgeries there are in New York City or how many abortions they produce. But law-enforcement officials and medical experts say dozens of these clinics are believed to be tucked away behind storefronts and in more ordinary-looking doctors' offices and they are believed responsible for scores or even hundreds of illegal or incompetent abortions annually.

And beyond the numbers, experts say, lies the suffering of women who seek illegal abortions -- those in the last trimester of pregnancy with the mother's life not in danger -- or who are victimized by incompetent abortionists because they are poor and uneducated, do not speak English or do not know how to find a good clinic, evaluate medical treatment or file a complaint if things go wrong. No Questions, No Advice

"I would tell Hispanic women that when you have this procedure done, to check the place, check the circumstances," said Doris Olivo, a 29-year-old Dominican woman who says she was a victim of a botched abortion. She told of an ordeal in a filthy office with a doctor who asked no questions, administered no tests, demanded $150 in cash and was not available later when complications developed.

In recent days, after a Lower East Side doctor, Abu Hayat, was accused of severing the arm of a fetus in a botched, and illegal, abortion, a score of women like Ms. Olivo have filed criminal complaints and lawsuits and told of uterine and cervical cuts, hemorrhages, infections and other nightmares under the knife.

They have also turned a spotlight on the chilling secrets of sleazy abortion mills -- most of them run by licensed doctors who use their offices as abortion "clinics," but are not licensed as full-fledged abortion clinics and are thus not subject to rigorous state standards and periodic inspections.

Dr. Hayat, through his lawyer, has said he has not acted illegally or performed improper abortions. Attempts to reach the doctor or his lawyer last night to comment on Ms. Olivo's complaints were unsuccessful.

While the Manhattan District Attorney's office is investigating Dr. Hayat for another botched abortion that led to a young woman's death last year, and the State Health Department is considering a revocation of his medical license, the case has raised far deeper questions about the small but vampirish world of medicine that operates on the fringes of legality and the Hippocratic Oath.

And the experiences of women who have entered that world illustrate its perils and some weaknesses of the agencies responsible for policing the medical profession. Choosing a Doctor From an Ad

In 1989, Ms. Olivo, who is the mother of two children, said she decided to have an abortion because one of her sons had been born handicapped and because she was jobless and could not support a third child. Like many women, she learned of Dr. Hayat in an advertisement in El Diario.

Taking a doctor's name from an ad is hardly sufficient to find a good doctor or clinic. Peter Slocum, a spokesman for the State Health Department, said that if there is no family physician to make a recommendation, one can call county medical societies, any hospital or the larger, better known clinics like Planned Parenthood for advice.

There are three legal options for a women seeking an abortion, Mr. Slocum noted. In New York City, they may be performed only in hospitals or their outpatient clinics, in the offices of licensed physicians and in dozens of abortion clinics that are owned by 12 licensed corporations, like Planned Parenthood.

As defined by the state, licensed abortion clinics are not just places where several doctors join their practices. Rather, they are corporations that hire doctors; meet rigorous state standards for equipment, procedures, cleanliness and staff training, and must be inspected for licensing and have periodic inspections thereafter.

All licensed abortion clinics are required to have emergency backup plans to take a patient in distress to a local hospital. State officials stress that these legitimate abortion clinics should not be confused with abortion mills, where nearly all of the illegal or incompetent abortions occur.

These are usually private doctors' offices masquerading as clinics -- that is, the doctors are licensed, but the clinics are not. Many of the mills, though not all, are situated in poorer neighborhoods, where immigrants, the uneducated and non-English-speaking residents form a core of clients.

Cost was a major factor for Ms. Olivo, who was attracted by Dr. Hayat's $150 price. Some abortion mills now charge $1,500 or more, patients say, while legitimate clinics charge $300 to $500. Many poor women are unaware that New York is one of the few states that cover abortions under Medicaid.

After reading the advertisement, Ms. Olivo called Dr. Hayat's clinic, then located at 820 Broadway in the Williamsburg section of Brooklyn. "They said I didn't need an appointment," she recalled. The clinic, in a second-floor office, had little equipment. Little Equipment And No Tests

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The lack of equipment was a signal that something was wrong. Most mills, officials said, lack such proper equipment as sonogram or ultrasound machines that help determine the age, size, position and other vital data on a fetus. Sonograms are normally required after the 12th week of pregnancy.

No questions were asked, Ms. Olivo said, and no tests were administered -- not even one to confirm she was pregnant, let alone one to learn the age of the fetus -- and these were further signs that the clinic was not a good one, officials said.

"I asked them how they knew I was pregnant and they said they just knew," she said. "I had told them I was pregnant and they took my word for it."

Ms. Olivo said she believed she was in the first trimester of pregnancy. Abortions in New York are legal only in the first two trimesters, or 24 weeks of pregnancy. But officials say some abortion mills make no effort to determine the age of the fetus and illegally abort pregnancies in the third trimester. After the 24th week, a pregnancy may be ended only in a hospital and only if the mother's life is in danger.

Ms. Olivo paid cash in advance. After a 30-minute wait, she said, the nurse took her into a room, put her on an examining table and injected her with what proved to be an ineffective anesthetic. Then, she said, Dr. Hayat appeared and, without a word, began the abortion.

"It lasted two minutes," she said. "While he was doing it, I could feel everything." After a few minutes in a small recovery room, she said, she was sent home and told to call if she felt ill. There was pain in her abdomen, and later it became worse. "I felt sick at my house," she said. "I had a lot of cramps and pains."

Four days later, the pain and cramps were still growing worse. She went to a hospital and was admitted with a 103-degree fever. A doctor examined her, found that she had endured an incomplete abortion and removed parts of the fetus that were still in her uterus. After five days, she went home.

Later, Ms. Olivo returned several times to Dr. Hayat's office "to tell him how I felt," but was told each time that he was not there. That, officials say, is also typical of abortion mills, which provide little if any follow-up care.

Now, two years later, Ms. Olivo is still weak from the experience. She said she was stunned by reports last week that the doctor had botched other abortions. She said she wanted to sue him, but knew now that she could never collect damages.

"I would never have imagined that a clinic wouldn't have insurance," she said. "I thought it was required by law that you have insurance." But Mr. Slocum said doctors are not required to have medical malpractice insurance, and other officials said it was unlikely that abortion mills had such insurance. Hard to Police A Shadow World

The realm in which Dr. Hayat operated is a largely hidden one. The State Health Department, which licenses doctors and dozens of legitimate abortion clinics in the city and investigates complaints of malpractice and negligence against physicians, acknowledges that it does not know enough about illegal or incompetent abortion mills and says it needs more authority to regulate them.

"We don't know as much as we'd like to," Mr. Slocum said. "They're underground, unfortunately, and we learn about them only when someone files a complaint or ends up in an emergency room. All we can see is the surface, but that is troubling to us. We suspect there is a lot more we don't see."

Most women who have abortions in New York encounter no problems. Of 150,000 abortions reported in New York State (95,000 of them in New York City) in 1989, the latest year for which figures were available, fewer than 2,800, or less than 2 percent, involved any medical complications and only a handful of those may have involved actual negligence or incompetence.

"The vast majority of abortions are performed safely and without negligence or complications, but there are some very bad actors out there -- and a handful can cause a lot of damage," Mr. Slocum noted.

But policing the incompetence is difficult. Only one doctor in 1989 had a license summarily suspended for gross misconduct in an abortion, Mr. Slocum said. Indeed, he said, there have been only four other summary suspensions -- emergency actions invoked before hearings on charges -- related to abortions in the last six years -- one in 1985, one in 1990 and two this year.

While the state regulates and inspects the legitimate clinics, it lacks the authority and staff to regulate and inspect doctors' offices, and can only challenge a doctor's license after a complaint and an investigation. And many clients, even if dissatisfied, are reluctant to file a complaint.

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A version of this article appears in print on November 24, 1991, on Page 1001001 of the National edition with the headline: Abortion Mills Thriving Behind Secrecy and Fear. Order Reprints|Today's Paper|Subscribe